W03 - PSYCH: Child & Adol. Psych; Eating Disorders; Personality Disorder Flashcards
Distinguish between the different eating disorders as well as between eating disorders and ‘feeding disorders’, and demonstrate awareness of the range of symptoms and behaviours involved.
- highest mortality rate amongst psychiatric symptoms
- all share features of pre-occupations
BULIMIA NERVOSA
* eating large amounts of food with a loss of control over the eating — and then purge, trying to get rid of the extra calories in an unhealthy way.
* purging Vs non-purging
ANOREXIA NERVOSA
* Relies on compulsive compensatory behaviours when food cannot be avoided, Self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics.
BINGE EATING DISORDERS
* repetitive cycles, similar to bulimia nervosa with nil purging, ‘buzzed’ after eating
- Other specified feeding or eating disorder (OSFED)
*Avoidant Restrictive Food intake disorder. ( ARFID)
Analyse the predisposing, precipitating and perpetuating factors contributing to the onset of eating disorders.
*obsessive fear of fatness, avoidance food and sources of calories
PREDISPOSING:
high risk obsessionality
genetic
perinatal
PRECIPITATING:
life events - trauma
puberty
dieting
exercise
PERPETUATING:
consequences of starvation syndrome
- delayed gastric emptying
- narrowing focus
- obsessionality
- high emotional expression: families, school, clinic staff
Describe evidence-based treatments for the management of the different disorders
- specialist centres associated with lower mortality rates
- Average time for recovery from anorexia nervosa – where this occurs – has been estimated at 6 – 7 years.
> Re-feeding = vital in ensuring good response to medication and psych. support and intervention
> Psych. Support & Rx.
CBT-ED
MANTRA
SSCM
CBT + self-help
> IPT, fluoxetine
> Olanzapine
> Family work
+ Dietary advice and education
+ Medicine for psychological symptoms
+ bone health
- follow-upss
Demonstrate the use of motivational approaches and the technique of ‘externalising the disorder’.
*motivational and open approach to combat feeling of isolation.
*controlling impulses => from EXTERNALISING DISORDERS (vs INTERNALISED)
- Externalizing disorders are often specifically referred to as disruptive behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders.
Manage risk of death and of irreversible physical damage appropriately in patients with severe eating disorders
- assessment of risk of profound electrolyte disturbance
- severe wt loss
- <40bpm
- severe dehydration; fluid refusal
- hypothermic
- prolonged QT complex
Prioritise nutritional concerns in the management of the mental and physical health of all patients, whether or not they have formal eating disorders
> Re-feeding = vital in ensuring good response to medication and psych. support and intervention
TIDE
DM with eating disorder
- insulin omission
*food restricition A/nervosa variant
- CHO avoidance/restriction
- binging/bulimic variant
- intentional insulin omission
= ketoacidosis high risk - Diabetes Eating Disorder Survey – Revised DEPS- R . 16 item questionnaire, diabetes specific , self-reported measure of disordered eating
Anx. Nervosa Signs & Symptoms
cold intolerance: peripheral wasting, dt cardiac muscle weakening = maintenance of core.
blue hands feet
GI bloating / constipation
delayed puberty, Primary or secondary
amenorrhea
dry skin
fainting
fatigue, weakness
haair symptoms
Osteopenia & osteoporosis
Bulimia Nervosa Signs & Symptoms
Pharyngeal trauma
esoph rupture
dental caries, mouth sores
Heartburn, chest pain
impulsivity
Muscle cramps
Weakness
Bloody diarrhoea
Irregular periods
Fainting
Swollen parotid glands
hypotension
*K+ loss = cardiac arrhythmia risk
Link to anorexia nervosa and reynauds
some may come in to mask their anorexia nervosa = low wt, peripheral wasting
To be able to discuss the impact of genetics, family and the wider social environment on the development and maintenance of psychiatric disorder in young people.
*early life hx, genogram significance, personal hx etc.
+ temperment, likes/dislikes
+ in-utero stress = LT dmg
+ collateral hx
PREDISPOSING
* genetics, toxic in-utero, birth compl., insult
PRECIPITATING
* iatrogenic rection, substance misuse
* new stress
* school/home changes = stress
PERPETUTATING
* poor response to meds, pain, illness
* personality, coping, self-belief, world outlook
PROTECTIVE
* diet, sleep, genes, exercise, intelligence
* cognitive strategies, coping, psychologically minded
* faith, community, family
To recognise the features of the common psychiatric disorders that affect young people.
a
To be aware of the impact that child psychiatric disorder may have on normal developmental processes, the family and later adult life.
a
ADHD features and mgmt
- 6 months inattention and/or hyperactivitity-impulsivity
- present before 12, M>F
- hyperactive-impusive symptoms recede vs persisting inattention
= functional negative impact
- Conners index
(1)
> parent training programme
+ school adjustments
(1)
> Methylphenidate
2. >Lisdexamphetamine
3. >Atomoxetine (non-stimulants)
- monitor growth, baaseline obs, cardiac events hx
Autism Spectrum Disorder features and mgmt
- IMPAIRMENTS IN RECIPROCAL SOCIAL INTERACTIONS
- DIFFICULTIES WITH SOCIAL COMM
- RESTRICTED, REPETITIVE, INFLEXIBLE PATTERNS OF INTEREST / BEHAVIOUR
*early childhood
= impaired functioning
+ impaired functionl language, intellectual dev.
M>F
